血小板及其表面受体配体在脓毒症凝血病中作用的研究进展

Role of platelets and their surface receptors and ligands in septic coagulopathy

血小板是小的无核血细胞,是重要的止血物质,近年研究发现血小板在炎症和免疫反应中起着至关重要的作用。脓毒症期间,多种因素刺激血小板活化,特别是脂多糖,其通过刺激血小板分泌来促进血小板活化并增强血小板聚集。活化后的血小板表达多种受体,其中P-选择素在炎症反应中起着始动作用,而GPⅡb/Ⅲa活化并与纤维蛋白原结合是各种原因所致的血小板聚集的共同途径和必需环节,两者在脓毒症凝血病中发挥着至关重要的作用。活化后的血小板与白细胞、内皮细胞相互作用,催化过度炎症反应和凝血功能失调,导致弥散性血管内凝血状态和微循环血栓形成,最终导致多器官功能衰竭。另外活化的血小板脱落血小板产物,即血小板衍生膜微粒,其增强了炎症和凝血。本文综述了目前血小板及其表面受体配体在脓毒症凝血病中作用的研究进展。

Platelets are small anuclear cells that have a critical role in hemostasis.Recent studies have found that platelets play an important role in inflammation and immune response.In sepsis,multiple factors stimulate platelet activation,especially the lipopolysaccharide,which promotes platelet activation and enhances platelet aggregation by stimulating platelet secretion.The activated platelets express a variety of receptors,among which P-selectin plays an initiating role in the inflammatory response.Moreover,GPⅡb/Ⅲa activation and binding to fibrinogen is a common pathway and essential step for platelet aggregation caused by various causes.Both P-selectin and GPⅡb/Ⅲa play a vital role in septic coagulopathy.Activated platelets interact with leukocytes and endothelial cells,catalyzing excessive inflammatory response and coagulation dysfunction,leading to disseminated intravascular coagulation and microcirculatory thrombosis,and eventually causing multiple organ failure.In addition,activated platelets shed platelet products,known as platelet-derived microparticles,which enhance inflammation and coagulation.This paper reviews the research progress in the understanding of the role of platelets and their surface receptors and ligands in septic coagulopathy.